Awake craniotomy for removal of intracranial tumor: considerations for early discharge

Abstract

We retrospectively reviewed the anesthetic management, complications, and discharge time of 241 patients undergoing awake craniotomy for removal of intracranial tumor to determine the feasibility of early discharge. The results were analyzed by using univariate analysis of variance and multiple logistic regression. The median length of stay for inpatients was 4 days. Fifteen patients (6%) were discharged 6 h after surgery and 76 patients (31%) were discharged on the next day. Anesthesia was provided by using local infiltration supplemented with neurolept anesthesia consisting of midazolam, fentanyl, and propofol. There was no significant difference in the total amount of sedation required. Overall, anesthetic complications were minimal. One patient (0.4%) required conversion to general anesthesia and one patient developed a venous air embolus. Fifteen patients (6%) had self-limiting intraoperative seizures that were short-lived. Of the 16 patients scheduled for ambulatory surgery, there was one readmission and one unanticipated admission. It may be feasible to discharge patients on the same or the next day after awake craniotomy for removal of intracranial tumor. However, caution is advised and patient selection must be stringent with regards to the preoperative functional status of the patient, tumor depth, surrounding edema, patient support at home, and ease of access to hospital for readmission.

Implications: It may be feasible to perform awake craniotomies for removal of intracranial tumor as an ambulatory procedure; however, caution is advised. Patient selection must be stringent with respect to the patient's preoperative functional status, tumor depth, surrounding edema, patient support at home, and ease of access to hospital for readmission.